What is the most likely cause for the vocal cord palsy?
Left vocal cord palsy is favoured secondary to metastatic thryoid carcinoma, particularly the papillary subtype, characterised by ill defined left mid pole thryoid lobe mass extending into left tracheo-oesophageal groove with adjacent left level III/IV partially calcified and cystic lymph node and suspicious rounded left level IV lymph node.
Hypoattenuating ill-defined mass measuring 2.0 x 1.8 x 2.3 cm located at the posterior aspect of the left thyroid lobe mid pole which is inseparable from the left thyroid lobe itself and extends into the left tracheo-oesophageal groove. Separate 1.4 cm hypoattenuating nodule in the lower pole of the left thyroid lobe. The right thyroid lobe is unremarkable. Enlarged heterogeneous lymph node comprising cystic and calcified components measuring 1.9 x 1.3 cm in the level III/IV on the left, with smaller rounded but heterogeneous 8 mm level IV lymph node seen just beneath this. Left-sided vocal cord palsy.
Small non-calcified subpleural nodule measuring 4.4 mm in the posterior segment of the right lower lobe. The lungs and pleural spaces are otherwise clear.